The ASTRAL score to predict functional outcome in acute

ischemic stroke

Univers i ty of Thessa ly , Lar issa, Greece

George Nta ios

Let’s design the ideal prognostic score…

• not too many variables • readily available variables• simple to calculate• applicable as early as possible• widely-used scale for outcome assessment • validated externally • validated in large population• validated in multiple populations

•Modified Rankin Scale score•Barthel index•Glasgow outcome scale•Oxford Handicap Scale

ASTRAL registry (Lausanne/Switzerland)n=1645

Athens Stroke Registryn=1659

Vienna Stroke registryn=653

Development of the prognostic score

Double external validation of the prognostic score

Prognostic point-based score

Color chart

P=0.43

ASTRAL registry (Lausanne/Switzerland)n=1645

Athens Stroke registryn=1659

Vienna Stroke registryn=653

Development of the prognostic score

Double external validation of the prognostic score

Prognostic point-based score

Color chart

P=0.22

P=0.49

P=0.82

ASTRAL registry (Lausanne/Switzerland)n=1645

Athens Stroke Registryn=1659

Vienna Stroke Registryn=653

Development of the prognostic score

Double external validation of the prognostic score

Prognostic point-based score

Color chart

Take-home messages

• the ASTRAL score is a very reliable prognostic score• it calculates the probability of poor outcome at three months• it can be used already at admission• it is very simple to use, especially with the help of the color chart

Spare slides

Stroke 2002; 33: 1041-1047

Oxford Handicap Scale score < 3

logit(BI<95) = -5.782 + (0.049*age) + (0.272*NIHSS)

Stroke 2004;35:158-162

Stroke 2008;39;1821-1826

-ASTRAL score- Validation in pooled Athens/Vienna dataset

-Score by Weimar et al.- Validation in the VISTA dataset

Stroke 2008;39;1821-1826 Neurology 2012;78:1916–1922

Stroke 2011;42:3421-3428

Stroke 2011;42:3421-3428

Stroke 2011;42:3421-3428

P=0.43 P=0.22

P=0.49 P=0.82

5-year unfavourable outcome (mRS=3-6)

5-year mortality

ASTRAL score (per 1 point increase)

1.09 (1.08 – 1.10)* 1.09 (1.08 – 1.10)*

Atrial fibrillation 1.53 (1.14 – 2.04)†

Heart Failure 1.56 (1.14 – 2.13)†

Stroke subtypes 1 1 Lacunar 1.71 (1.10 – 2.66)‡ 1.14 (0.67 – 1.94) Atherosclerotic 1.65 (1.03 – 2.63)‡ 1.74 (1.02 – 2.97)‡

Cardioembolic 2.82 (1.84 – 4.34)* 2.39 (1.46 – 3.93)*

Undetermined 0.74 (0.58 – 0.95)‡

Predictors of long-term outcome